Healthcare Provider Details

I. General information

NPI: 1902851066
Provider Name (Legal Business Name): PIERCE & RIOS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36618 SOUTH LASSEN POB 1269
HURON CA
93234
US

IV. Provider business mailing address

PO BOX 189
LEMOORE CA
93245-0189
US

V. Phone/Fax

Practice location:
  • Phone: 559-945-9000
  • Fax: 559-945-9009
Mailing address:
  • Phone: 559-945-9000
  • Fax: 559-945-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberRHM08905F
License Number StateCA

VIII. Authorized Official

Name: DR. DOLPHUS D PIERCE II
Title or Position: OWNER ADMINISTRATOR
Credential: D.C.
Phone: 559-905-9000